Version 2 Development and Implementation

1. Version 2 Development and Implementation CSv2 Process Review Session March 23-24, 2010 Chicago, IL

2. CS Process Review Session What Worked Well

3. What Worked Well • Communication • Broad input from various stakeholders • Communication among and between CSv2 work groups and management team • Opportunity to share information, open communication • Use of technology to enhance communication • Relations with vendors

4. What Worked Well • Training • Using web-based training • Identification of trainers for CSv2 • Dedicated web site for support • High quality educational materials

5. What Worked Well • Organization of the Project • Structure worked well • Project Leader • Committees with specific tasks • Reporting back to project management team • Team structure-others’ expertise contributed new ideas, concepts, perspectives • Informatics structure-programming and testing

6. What Worked Well • People • Many dedicated people with subject matter expertise • AJCC staff support • Willingness of most team members to work together • Talented and experienced technical leadership • Major players were involved

7. CS Process Review Session What Didn’t Work Well

8. What Didn’t Work Well • Communication • Not enough communication with cancer registry and surveillance community, vendors about progress • Not an open dialogue, power imbalance • Scope of Project • Project was bigger than most imagined—huge workloads

9. What Didn’t Work Well • People • Too much reliance on volunteer staff • Project Management/Leadership Structure • Reporting structure-Decision-making process within teams/ authority/consensus/ problem-solving

10. What Didn’t Work Well • Project Management/Leadership Structure (continued) • No change request process in place—formal log, tracking system, parking for issues in the future • Project management-resolving issues, not an open dialogue • Ineffective team management/leadership • Lack of defined authority structure

11. What Didn’t Work Well • The Process • Repeatedly missed deadlines • Unrealistic schedule—lack of adequate time for all the steps in the process • Prep of AJCC chapters missed expected deadlines • From the beginning, lack of input from registrars

12. What Didn’t Work Well • The Process (continued) • Needed early triggers to help make decisions about the process • Who can make decision to delay implementation deadlines • Recommendations for individual teams-set up a process for change requests • Style manual for mapping team

13. What Didn’t Work Well • Training • Training and materials were developed too early

14. CS Process Review Session What To Do Differently

15. What To Do Differently • Project Management • Create formal project management structure and plan • Hire staff • Identify resources • Timeline • Refine timeline and stick to it, with milestones to trigger decisions • More lead time-begin process earlier

16. What To Do Differently • In the Beginning • Involve registrars • Responsiveness from AJCC authors, more control over the chapters to ensure consistency • Analyze what can be collected and how it can be collected prior to starting the process • Determine balance between being up to date clinically and burdening the registries

17. What To Do Differently • In the Beginning (continued) • Assess who is using registry data and for what purpose. • Evaluate the cost benefit of additional data items.

18. CS Process Review Session Concurrent Development of AJCC 7th Edition and CSv2

19. Concurrent Development • Yes • Many questions could be answered before the chapter was complete • Back and forth clarification/synchronization lead to better products on both ends • AJCC 7 and CSv2 linked together by item number and site-specific factors • CSv2 software includes new staging algorithms based on the AJCC 7th edition

20. Concurrent Development • Yes, if…. • Registrar on each AJCC task force would have lead to the AJCC manual and CS being more in line • Chapter authors were more available to answer mapping team members’ questions • More involvement of data users in assessing the feasibility and usefulness of future changes

21. Concurrent Development • No • CSv2 mapping was impeded by constant changes • At no point was there a stable system to test adequately • Large time burden on the CS project at the very end • Caused extreme hardship and difficulties in system development and testing

22. Total Resources for CS 2009 Direct Dollars and In-kind Contributions • Total Financial Contributions for 2009 • 2,097,107 est. • Total in-kind Contributions for 2009 • $50,000 est. • Total project hours • 24,000 est./600 work weeks/12 full-time staff working 52 weeks per year • Doesn’t include team member meeting participation

23. Moving Forward • AJCC Perspectives/CSv2 Maintenance • 6 FTEs + contractor support • 2 mappers • 1 programmer/IT specialist • 1 educator/trainer • 1 study specialist/analyst • .5 project manager • .5 admin asst. • Contracted team leads/clinical advisor • Volunteer team members • $620,000 est. • $520,000 salary and benefits • $25,000 contractor fees • $75,000 general operating expenses (meetings, conf. calls, etc.)

24. Moving Forward • AJCC Perspectives/Resources for CSv3 • 13 FTEs + contractor support • 4-5 mappers • 2-3 programmer/IT specialist • 1 educator/trainer • 1 documentation developer/specialist • 1 study specialist/analyst • 1 project manager • 1 admin asst. • Contracted team leads/clinical advisor • Volunteer team members • $1,269,000 est. • $1,144,000 salary and benefits • $50,000 contractor fees • $75,000 general operating expenses (meetings, conf. calls, etc.)

25. Moving Forward • …..with current funds • CSv2 Maintenance • $602,00 estimated • $322,019 available • $297,981 deficit • CSv3 Development • $1,269,000 estimated • $322,019 available • $946,981 deficit

26. Next Steps • Hire a program manager and additional core/dedicated staff • Flow chart/define all components of CSv2 development process • Collaborate more closely with AJCC on staging system revision process • Develop a comprehensive project plan for annual vs. major version releases • Define budgetary needs • Develop pools of expertise around mapping and IT tasks • Evaluate and redefine teams and members • Train AJCC task force members/clinicians about CS • Define feasibility criteria and evaluate scope of changes • Engage the registrar and vendor communities early in the development process • Build in vetting, feasibility, and pilot testing of new concepts/major changes • Evaluate new technology environments for CS architecture

27. Next Steps in 2010 • Data Validation Project • Review of site-specific schemas and tables for consistency, completeness and accuracy • Will result in some code changes and new codes • Conversion designed to handle majority of changes • Next major version release – Fall 2010 • Will incorporate all changes from data validation • Implementation Guide Revision • Posted on CS Web site this week • Clarifications to data items and processing of 2010 cases collected under CSv1 • Education and Training continues • Part 1, Section 1 Coding Instructions • Part 1, Section 2 Site-Specific Factors • Additional topics being developed • Field Test being planned for 2011

28. CSv2 Tools • SEER Abstract Addendum Generator • For 2010 cases abstracted under CSv2 • Tool lists CS fields and space to abstract CSv2 pending software updates • CSv2 case exercises and answer sheets • Available for self-study on CS Website • Breast, prostate, colorectal • Printed Manual • NCRA planning mid-summer release of coding instructions and schemas • Price is $145 for NCRA members • Visit NCRA Web site • Site-specific schema in pdf • Available from CS Web site • Grouped by anatomic site, i.e., lower GI includes appendix, carcinoid appendix, GIST, etc. • Download schemas as needed, versus ALL